Lantus 100iu per ml
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Lantus insulin glargine 100 IU/ml drug information pharmacology
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Here is a comprehensive overview of Lantus (Insulin Glargine) 100 IU/mL:
Lantus (Insulin Glargine) 100 IU/mL
Formulation & Brands
- Generic name: Insulin glargine
- Concentration: 100 units/mL (U-100)
- Brand names: Lantus, Basaglar, Semglee, Toujeo (Toujeo is a higher-concentration formulation at 300 units/mL)
- Class: Long-acting basal insulin analog
Mechanism of Action
Insulin glargine is engineered by altering the isoelectric point of the insulin molecule, making it less soluble at physiological pH. After subcutaneous injection, it forms a microprecipitate at the injection site from which insulin is slowly released into the circulation over an extended period. This produces a flat, peakless pharmacodynamic profile — unlike NPH insulin which has a distinct peak — providing smooth basal glucose control over ~24 hours.
At the receptor level, it binds the insulin receptor (a tyrosine kinase receptor), promoting:
- Glucose uptake into muscle and adipose tissue (via GLUT4 translocation)
- Glycogen synthesis in liver and muscle
- Suppression of hepatic gluconeogenesis
- Inhibition of lipolysis and ketogenesis
Pharmacokinetics
| Parameter | Detail |
|---|---|
| Onset | 3–4 hours after subcutaneous injection |
| Peak | No pronounced peak (flat profile) |
| Duration | ~24 hours (up to 24 hours) |
| Route | Subcutaneous injection only (never IV) |
| Administration | Once daily, can be given at any time of day |
Dose, injection site, blood supply, temperature, and physical activity can all affect onset and duration.
Indications
- Type 1 diabetes mellitus — basal insulin component, combined with rapid-acting insulin at meals
- Type 2 diabetes mellitus — basal glucose control when oral agents ± GLP-1 agonists are insufficient
- Pregnancy — previously category C; safety data has evolved (check current guidelines)
Dosing Principles
- Basal insulin requirement is assessed by fasting glucose levels
- Average doses in type 1 DM: ~0.6–0.8 units/kg/day (total daily dose)
- Given once daily at any consistent time
- Adjust dose based on fasting glucose targets (typically fasting BG 80–130 mg/dL per ADA)
Important Clinical Points
⚠️ Do NOT mix with other insulins — mixing glargine with rapid-acting insulins (e.g., lispro, aspart) in the same syringe alters its pharmacodynamic profile and defeats the peakless mechanism.
Subcutaneous use only — never administer intravenously.
Perioperative management: Patients may be instructed to take approximately half their usual dose the evening before surgery.
Adverse Effects
| Effect | Notes |
|---|---|
| Hypoglycemia | Most serious and common; risk lower than with NPH due to absence of peak |
| Weight gain | Common with insulin therapy generally |
| Injection site reactions | Local irritation, redness |
| Lipodystrophy | Atrophy or hypertrophy of subcutaneous fat; minimized by rotating injection sites |
Comparison with Other Long-Acting Insulins
| Insulin | Mechanism of prolonged action | Duration |
|---|---|---|
| Glargine (Lantus) | Microprecipitate from altered isoelectric point | ~24 h |
| Detemir (Levemir) | Fatty acid chain → albumin binding, slow dissociation | ~18–24 h |
| Degludec (Tresiba) | Multihexamer depot formation | >42 h (longest) |
| NPH | Zinc-protamine complex, less soluble | ~12–18 h (has peak) |
Contraindications / Cautions
- Do not use for acute glucose lowering (e.g., DKA) — use IV regular insulin instead
- Reduce dose in renal insufficiency (reduced insulin clearance)
- Pregnancy: previous concerns about mitogenic activity; current guidelines should be consulted for updated recommendations
- Avoid inhaled insulin formulations (Afrezza) in asthma/COPD — not applicable to glargine but relevant when selecting insulin type
Sources: Lippincott Illustrated Reviews: Pharmacology; Rosen's Emergency Medicine; Tintinalli's Emergency Medicine; Creasy & Resnik's Maternal-Fetal Medicine
When will give this related to sugar level
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Here is a clear guide on when to give Lantus (insulin glargine) based on blood sugar levels:
When to Give Lantus Based on Blood Sugar (Glucose) Levels
1. When is Lantus indicated in the first place?
Lantus is started when blood glucose is not controlled by oral medications alone:
| Situation | Blood Sugar Threshold to Consider Starting Lantus |
|---|---|
| Type 2 DM — poor control on oral agents | HbA1c persistently >7–8% despite oral medications |
| Fasting blood glucose consistently elevated | Fasting BG >130 mg/dL repeatedly |
| Type 1 DM | Always required as basal insulin from diagnosis |
2. Blood Sugar Targets While on Lantus
| Time | Target |
|---|---|
| Fasting (before breakfast) | 90–130 mg/dL |
| 2 hours after meals | < 180 mg/dL |
| Rise from pre-meal to post-meal | ≤ 50 mg/dL increase |
| HbA1c goal | ≤ 7% (for most patients) |
Lantus controls fasting glucose specifically. If fasting BG is high, the Lantus dose is too low. If fasting BG is low (hypoglycemia), the dose is too high.
3. How to Titrate the Dose Based on Fasting Blood Sugar
Once Lantus is started, the dose is adjusted according to daily fasting glucose readings:
Increase by 1 unit per day until fasting blood glucose is < 100 mg/dL
A simple titration rule commonly used:
| Fasting Blood Glucose (average over 3 days) | Dose Adjustment |
|---|---|
| > 180 mg/dL | Increase by 4 units |
| 140–180 mg/dL | Increase by 2 units |
| 110–139 mg/dL | Increase by 1 unit |
| 90–109 mg/dL | No change (target reached) |
| < 90 mg/dL (or any hypoglycemia) | Decrease dose |
4. When NOT to Give Lantus (Hold or Reduce)
- Blood sugar < 90 mg/dL (fasting) → reduce dose
- Active hypoglycemia (BG < 70 mg/dL) → withhold, treat hypoglycemia first
- Patient is fasting / not eating (e.g., before surgery) → give half the usual dose the night before
- Severe illness / DKA → switch to IV regular insulin; Lantus is not appropriate for acute correction
5. Key Rule to Remember
Lantus controls fasting blood sugar, NOT mealtime blood sugar.
- If fasting BG is high → adjust Lantus dose
- If post-meal BG is high but fasting is normal → adjust the rapid-acting insulin (e.g., NovoLog, Humalog), not Lantus
Quick Summary Table
| Blood Sugar Reading | Action |
|---|---|
| Fasting BG > 130 mg/dL (persistent) | Start or increase Lantus |
| Fasting BG 90–130 mg/dL | Lantus dose is correct — maintain |
| Fasting BG < 90 mg/dL | Reduce Lantus dose |
| BG < 70 mg/dL (hypoglycemia) | Hold Lantus, treat hypoglycemia |
| Before surgery | Give 50% of usual dose |
Sources: Textbook of Family Medicine 9e (Unger, 2007 protocol); Lippincott Illustrated Reviews: Pharmacology; ADA Guidelines (HbA1c ≤7%, fasting BG 90–130 mg/dL)
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